Relevance of the current discussion on prioritization for rheumatology

Abstract

The increase in age-related diseases that can be expected due to demographic changes, the growing medicalization and the medical technological progress with new diagnostic and therapeutic methods, will probably lead to rising health expenditure in the coming years. The resulting financial problems have so far mostly been countered by an increase in health insurance contributions, tax subsidies, rationalization and hidden rationing. The potentials of explicit prioritization processes have so far not been made use of in Germany compared to some other countries where this is already in common use. Prioritization in the healthcare system is a procedure of mental clarification and determination of the priority or subordination of certain indications, patient groups or methods with the result of multilevel ranking. Human dignity, equality and solidarity are fundamental values on which prioritization is based. The medical need, the urgency of treatment, the expected medical benefits, the treatment risk, the cost efficiency and the evidence level are criteria towards which prioritization is oriented. Prioritization processes lead to scientifically substantiated care recommendations which support decisions regarding the medically rational, ethically justifiable and economically meaningful use of limited resources. In order to gain broad public acceptance, prioritization guidelines should be developed in a transparent way by democratically justified committees the composition of which still needs to be clarified. Fundamental concepts, cornerstones of the current debate and efforts that have already been made to make progress in this field are presented in summarized form in this article.